SONEIDENTIAL PERSONAL HISTORY STATEMENT FILE NR, INSTRUCTIONS 1. Answer all questions completely; if question is not applicable write “NA” Write “Unknown only i you do nat know the answer and if tha answer cannct be rived fom personal records. Use the blank poges at the back of this form for extra tails on any question for which you do not have sufficient space. 2 Type. print, or write carefully: illegible or incomplete forms wil nét receive due consideration. WARNING 1. The conectness of all statements of entries mace herein may be ‘ascertained through investigation, 2 __Any deliberate omission oF distortion of information may give sufficient ‘cause for derial of clearance and unfavorable resuit ofthe investigation, 3. The statements made herein are classified CONFIDENTIAL. Revelation cus an tn auorend prose PNP secu * PERSONAL DETAILS aebinccaanl ‘Home Address (include Street & No) PURSK MAOACIGON MARAYAG LUPeY DEXAD ORIENTAL Ben daw Av Etna ireglacs: “Neve | Nicknames. ree Te ~ [Nationality FIPINO TIN 42-584 S85. Ree 2q3e7eqide p TONe: fice Ee Phil Heat PAGIBIG I ne {Phi Heat SR eT IL” PERSONAL CHAR [Sex ee a ena eg pears aM Brera ‘Color of Hair PLEC ne Samoa [Seca ilramsaee — CONFIDENTIALSONEIDENTIAL (ii MARITAL HISTORY Date & Place of Mamiage we 1 Cenas — I PN iii air ni eceecicnte WV. FAMILY HISTORY AND INFORMATION ‘A. Father JONNIE Gs CDIAHON Dale of Binh MY 17 TAUH ities Sees So = [Pisce Bik PURLYSG UPON pKWo ORIENTAL | [Actress MARAYAG — LUCON DaVAD “ORIeUrEL ‘Oceupation and Piace of Employment FATE Mere neers se eee ates ae Meum p -eoumoy | Pe@aaaey 20 fade eal Pparmerans WaRbAG LUC Dayo CRIEWRE = RAS oa lg ements | ee J Ree eee | Goneipen LGONEIDENTIAL \V. EDUCATIONAL BACKGROUND 1 See ~TUocation | inclusive ‘Year | Awards Cowal |Cextai | Rese |tence_| yar | ear eu is “wart 20. 200 | 2007 2014 (—jnalusive Dates] “Adresses r 7 fist: 20> wees Signature: SONFIDENTIAL1k EMPLOYMENT inclusive Daler [Typo ot | NamelAdress of Employer | Reason for Leaving | employment : “2019 CENTRAUAL | ARG AULA BND OF GN TRACT peta AY SS cess | a | Pee Have you ever been dismissed or forced fo resign from a position? YES_ NOW” Iyes, state the reasonis, X. A. FOR POLICE COMMISSIONED OFFICERS ON ‘Sourée of Commission! | Please | Year | Indicate the Dale and Number of Appartment Entry tothe Officers. Chak Order Corp tral Technical al Line 04 — INSP. om eh ACTER REFERENCE ‘K. Give five (6) character references (known thos years or longer, who are not related to you) | ‘Narne GREGORIO MANGeoR THERA LUpN / 0°20 4759 398 Ya Ra MARA YA LUN] OTe 7699 NEF Reh FU nie UPKon LuPod] 08 DU GOS 3952 MPRALONA WwEAKES L4e MAERYAG LUPDN] O16 STE IT — ReLbAN BARU TAN IARAYAG WPOW | S975 ASC ED Signature \pline aw 07/20 20 go at ENTIALHAEEL D. FAULL MARAYAG LUPEN) DAKE BmTa,, TARY AON YRICUNAL — MARAYAG, \UPOU Davgo GerouTaL lita Sosee bre AG UIP Dilke eRIeutAL Xi PLEASE COPY IN OVIN HANDWRITING a Via ad Bana ae We Dy] bas gane jo Swizaland, Hevillz stying a Tote Zemat St forawook and wilte | iat Tus ond ome oring Pots Speriende Pay = “OW UENDEN BUSINESS [5 GOOD, BUT VIENAA PERN PEE BUNT. bon: LLOYD PE GENE TE BIDERAUD HE Grek BE Divaig aringe 2eenatr sh Fok a week aun wits Be SNe 1 Tuckey SWING patie SUPER EROENT CORY XIV. ORGANIZATION List organization oF social groups which you have beon a member: Organization ‘Address Dato of Membership & | I | XV. ADMINISTRATIVEICIVILICRININAL OFFENSE DATA OFFENSE CoMMTTED | TYPE CHARGE piseosmion | ASCHARGED | (Slate whathar (Eroneated, conveted, | scant oe ending) tether source of incom: 'B. Have you filed 2 eee Lisbities with any government agency. YES_ agency? | un? YES_ NO Wes, amount paid forte last] | calendar year pn | 'D. Do you uss iniexicaiing liquar of narcotics? VES? NOL Wes, towhat exert? TCeACIONALGY i E Languages or dislects RMU VIEAYEN, TAS QE | F. Hobbies, sports and pastime waster ea Signature {gbve ae ©%o/re GONEIDENTIA(Xvi. CERTIFICATION Teri that the Yoregaing answers are true and correct to the best of my knowledge and bolie and | agree that any ‘misstatement of omission 2s to material fac wil consti (ound for immediate denial of my appcation fr clearance. Signed at ahd Age aiviressy waters) 1 ye Repeat | 2 Re | a teen ae aa Mis | | THUMBMARKS coiticate No issued on Priipanes "Rank and Designation) — CONFIDENTIAL